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Case Reports
. 2024 May:118:109644.
doi: 10.1016/j.ijscr.2024.109644. Epub 2024 Apr 20.

Laparoscopic repair of a traumatic diaphragmatic rupture

Cedric M W Pesch  1 , Shiromani Janki  2 , Dashti Faraj  3 , Willem E Hueting  4
Affiliations
Case Reports

Laparoscopic repair of a traumatic diaphragmatic rupture

Cedric M W Pesch et al. Int J Surg Case Rep. 2024 May.

Abstract

Introduction and importance: Traumatic diaphragmatic ruptures following blast injury or penetrating trauma rarely present themselves with chronic symptoms warranting elective surgery.

Case presentation: We present the case of a 49-year-old man who survived a grenade explosion and experienced chronic chest pain. Considering the previous trauma, computed tomography imaging was performed and showed a left-sided traumatic diaphragmatic rupture ventral to the spleen, resulting in herniation of the transverse colon and omentum in the thoracic cavity. Metal shrapnel was located between the stomach and spleen, the suspected cause of the diaphragmatic hernia. The patient was eligible for minimal invasive laparoscopic surgery.

Clinical discussion: During surgery, a left diaphragmatic rupture and metal shrapnel on the right side of the rupture were found. The hernia was reduced and the metal shrapnel was removed, aiding in fully repositioning of the omentum and transversed colon. After which the left lower lung lobe was able to fully inflate. The rupture was closed using single V-lock sutures and strips of the Phasix mesh to reinforce the diaphragm repair with single ethibond sutures. No surgical or post-operative complications were observed and the patient did not experience any of his previous complaints.

Conclusion: In this case, laparoscopic repair of diaphragmatic rupture after penetrating trauma can be considered as an effective surgical approach.

Keywords: Blast injury; Case reports; Chronic disease; Diaphragm; Laparoscopy.

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Conflict of interest statement

Declaration of competing interest C. Pesch: no conflict of interest. S. Janki: no conflict of interest. W. Hueting: no conflict of interest. D. Faraj: no conflict of interest.

Figures

Fig. 1
Fig. 1
CT-thor/abd. with IV contrast, coronal cross-section
Fig. 2
Fig. 2
CT-thor/abd. with IV contrast, transverse cross-section.
Fig. 3
Fig. 3
Intra-abdominal view of diaphragmatic rupture and intra-thoracic positioned colon and omentum.
Fig. 4
Fig. 4
Intra-abdominal view of repositioned transverse colon and omentum.
Fig. 5
Fig. 5
Metal shrapnel of grenade removed from right side of diaphragmatic rupture.
Fig. 6
Fig. 6
Intra-abdominal view of repaired diaphragmatic rupture with Phasix™ ST Mesh.
See this image and copyright information in PMC

References

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